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Objective To investigate the etiological characteristics of infection after percutaneous biliary drainage or stent implantation in patients with malignant biliary obstruction (MBO). Methods Clinical data were collected from MBO patients who underwent interventional therapy in Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, from January 2016 to December 2020 and had or were suspected of biliary tract infection, with samples submitted for bile culture and/or simultaneous blood culture. Analysis was performed for the aspects of positive rate of culture, flora distribution, consistency between blood culture and bile culture, and drug resistance rate of major pathogenic bacteria. Results A total of 219 patients were enrolled, among whom 105(47.95%) were positive for bile culture, and the composition ratios of Gram-negative bacteria, Gram-positive bacteria, and fungi were 64.89%, 28.24%, and 6.87%, respectively. A total of 69 patients had samples submitted for blood culture during the same period of time, among whom 33(47.82%) had positive results. Positive results of both bile culture and blood culture were observed in 25 patients, and consistency analysis showed that the patients with complete consistency, partial consistency, and complete inconsistency accounted for 36%(9/25), 20%(5/25), and 44%(11/25), respectively. Common Gram-negative bacteria were Escherichia coli , Klebsiella pneumoniae , and Enterobacter cloacae , with a relatively low level of drug resistance to antibiotics including cefoperazone/sulbactam, amikacin, and imipenem. Common Gram-positive bacteria were Enterococcus faecium and Enterococcus faecalis , with a relatively low level(< 15%) of drug resistance to antibiotics including vancomycin, linezolid, and teicoplanin. Conclusion Common pathogens of infection after percutaneous biliary drainage or stent implantation in MBO patients include Escherichia coli , Klebsiella pneumoniae , Enterococcus, and Enterobacter cloacae . There is a relatively low level of consistency between blood culture and bile culture, and thus samples should be submitted for both tests.
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Objective To evaluate the efficacy of transcatheter arterial embolization (TAE) in treating oronasal cavity hemorrhage,and to discuss the the occurrence and prevention of complications.Methods The clinical data of 121 patients with refractory and fatal oronasal cavity hemorrhage,who were admitted to authors' hospital during the period from December 2005 to October 2013 to receive treatment,were retrospectively analyzed.A total of 116 patients were treated with TAE,and these patients were followed up for 1-3 months to evaluate the embolization effect and the occurrence of procedure-related complications was analyzed.Results Of the 116 patients,complete control of bleeding after TAE was achieved in 96 (82.7％),rebleeding within one week after TAE was seen in 19 (16.4％) and the bleeding was controlled by medication,and in the remaining one (0.9％) re-bleeding occurred within one week after TAE and embolization therapy had to be carried out again.No obvious complications occurred in 77 patients (66.4％);maxillofacial pain and numbness,low fever,limitation of mouth opening and other mild complications were observed in 35 patients (30.1％);one patient (0.9％) developed facial skin necrosis and severe headache;and 3 patients (2.6％) showed stroke symptoms due to cerebral embolism.Conclusion For the treatment of refractory and fatal oronasal cavity hemorrhage,TAE can quickly and effectively achieve the purpose of hemostasis;careful selection of proper embolization material based on the the different causes of bleeding and the responsible blood vessels is the key to ensure a successful TAE.The common postoperative complications include postembolization syndrome,local ischemia,local necrosis caused by peripheral ischemia;the main serious complications are skin necrosis of maxillofacial region and cerebral infarction caused by ectopic embolization.
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Objective To investigate the application value of prophylactic bilateral uterine artery catheterization and embolization in treatment of patients with pernicious placenta previa and accreta.Methods Data of 16 patients with pernicious placenta previa and accreta who underwent prophylactic bilateral uterine artery catheterization and uterine artery embolization and cesarean section were retrospectively analyzed.The amount of intraoperation blood loss,the amount of blood transfusion,cesarean hysterectomy rate,fluoroscopy operative time,radiation dose,complications and neonatal outcome were recorded.Results The technical success rate of the combined treatment was 93.75％ (15/16).The mean amount of blood loss was (1 575.00 ± 1 040.83)ml.The mean amount of blood transfusion was (3.44 ± 2.34)U leukoreduced red blood cells.The mean fluoroscopy operative time and radiation dose before delivery were (0.89±0.24)min and (7.17 ± 2.12)mGy.One newborn was diagnosed as severe asphyxia.The mean Apgar score of another 15 newborns was (9.38± 0.89) at 5 min after birth.One patient underwent hysterectomy due to postpartum hemorrhage complicated with disseminated intravascular coagulation.Buttock pain was found in 2 cases.Conclusion Prophylactic bilateral uterine artery catheterization and embolization can be used for the treatment of pernicious placenta previa and accreta.The combined treatment can control postpartum hemorrhage during placental dissection and reduce transfusion requirements and hysterectomy rate with few minor complications and low radiation exposure dose.